Why Does Your Head Ache?

Everything You Need to Know About Headaches

Headaches can be a minor annoyance or an important health issue. Get answers to all your headache questions, including why they strike and what you can do to stop them...

What hurts when you have a headache? Several areas of the head can contribute to pain, including a network of nerves that extends over the scalp and certain nerves in the face, mouth and throat.

Other contributors are delicate nerve fibers supplying muscles of the head and blood vessels found along the surface and at the base of the brain.

Stress, muscular tension, dilated blood vessels and other headache triggers can activate the ends of the nerves, called nociceptors, because they respond to intense stimulation.

A number of chemicals help transmit nociceptive-related information to the brain. Some of these are natural pain-killing proteins called endorphins, Greek for “the morphine within.”

One theory suggests that people who suffer from severe headaches and other types of chronic pain have lower levels of endorphins than people who are generally pain-free.

An estimated 45 million Americans experience chronic headaches.

What are migraine headaches?The most common type of vascular headache (those caused by abnormal function of the brain’s blood vessels or vascular system) is migraine.

Migraine headaches are usually characterized by severe pain on one or both sides of the head, often accompanied by nausea or an upset stomach, sensitivity to light and sound, and at times disturbed vision.

Other symptoms of this type of migraine, previously called classic, include speech difficulty, weakness of an arm or leg, tingling of the face or hands, confusion, and the appearance of neurological symptoms 10-30 minutes before the pain starts.

These symptoms, called an aura, can include flashing lights or zigzag lines and a temporary loss of vision. Aura symptoms last less than an hour and typically resolve before the head pain begins.

The pain of a classic migraine headache may be described as intense, throbbing or pounding and is felt in the forehead, temple, ear, jaw or around the eye.

Migraine starts on one side of the head but may eventually spread to the other side.

An attack lasts up to three pain-wracked days. Migraine sufferers may experience a variety of headache presentations, including sinus pain, neck tension and menstrual migraine, or have an aura without headache.

Migraine with the greatest occurrence in the general population is not preceded by an aura.

But some people do experience a variety of vague symptoms beforehand, including some mental fuzziness, mood changes, fatigue, and unusual retention of fluids.

During the headache phase of a migraine, a person may have diarrhea and increased urination as well as nausea and vomiting. With this type of migraine, pain can last three or four days.

Migraine can strike as often as several times a week or as rarely as once every few years, and it can occur at any time.

Some people, however, experience migraines at predictable times – for example, near menstruation or every Saturday morning after a stressful week of work.

What causes migraines?Research scientists are unclear about the precise cause. There seems to be general agreement, however, that key elements are excitability of neurons and blood flow changes in the brain.

People who get migraine headaches appear to have blood vessels that overreact to various triggers, including certain foods, strong or glaring light, intense odors, activity, emotions or cigarette smoke.

Triggers are not the same for everyone, and what causes a migraine in one person may relieve it in another. Triggers may be cumulative, and with exposure to multiple triggers, migraine may be more likely to occur.

Peak prevalence for migraine is ages 20-45 for both sexes. Migraine is often hereditary, and people who get migraines are thought to have an inherited abnormality in the regulation of blood vessels. They react abnormally to triggers such as stress and other normal emotions and biological and environmental conditions.

In addition to the types discussed above, migraine headaches can take several other forms, including:

Hemiplegic migraine – migraine with temporary paralysis on one side of the body. Some people may experience vision problems and vertigo about 10-90 minutes before the onset of headache pain.

Ophthalmoplegic migraine – pain is around the eye and is associated with a droopy eyelid, double vision, and other vision problems.

Basilar type migraine – occurring primarily in adolescent and young adult women and often associated with the menstrual cycle, these migraines involve a disturbance of a major brain artery at the base of the brain. Preheadache symptoms include vertigo, double vision, loss of consciousness and poor muscular coordination.

Benign exertional headache – brought on by running, lifting, coughing, sneezing or bending, this type rarely lasts more than several minutes.

Headache-free migraines – characterized by such migraine symptoms as visual problems, nausea, vomiting, constipation, or diarrhea without head pain.

The National Headache Foundation estimates that 60% of women who get migraine suffer from menstrual migraine headaches around the time of their menstrual period, which may disappear during pregnancy. Menstrual migraines are primarily caused by estrogen.

Other women develop migraine for the first time when they are pregnant, while some are first affected after menopause.

Investigators are studying hormonal changes in women with migraine in hope of identifying the specific ways these naturally occurring chemicals cause headaches.

TreatmentDrug therapy, biofeedback training, stress reduction, and elimination of certain foods from the diet are the most common methods of preventing and controlling migraine and other vascular headaches.

Other strategies include proper sleep habits, exercise, acupuncture, massage, heat and cold applications, and avoidance of behaviors or situations that may trigger an attack.

Drug therapy can be used to prevent the attacks or relieve symptoms after the headache occurs. In general, menstrual-related migraines can be managed effectively with strategies similar to those used for non-menstrual-related migraines.

What are tension or muscle-contraction headaches? Tension headache is named not only for the role of stress in triggering the pain, but also for the contraction of neck, face and scalp muscles brought on by stressful events. Ninety percent of all headaches are classified as tension/muscle contraction headaches, which can be divided into three categories, based on frequency of the attack. The pain is usually mild to moderate and feels like pressure is being applied to the head or neck.

According to the National Headache Foundation, approximately 78% of adults experience a tension-type headache sometime in their lives, with a slightly higher prevalence among women.

Episodictension-type headache occurs less than once a month and is usually triggered by temporary stress, anxiety, fatigue or anger. This is what most of us consider to be “stress headache.” It may disappear with the use of over-the-counter analgesics [pain relievers], withdrawal from the source of stress, or a relatively brief period of relaxation.

Frequenttension-type headache occurs one to 15 days a month.

Chronictension-type headache occurs 15 or more days a month and evolves over time from episodic headache; it can last for weeks, months and sometimes years.

The pain of these headaches is often described as a tight band around the head or a feeling that the head and neck are in a cast. The pain is steady and is usually felt on both sides of the head. Chronic muscle-contraction headaches can cause sore scalps – even combing one’s hair can be painful.

Occasionally, muscle-contraction headaches are accompanied by nausea, vomiting and blurred vision, but there is no preheadache syndrome, link to hormones or food, or hereditary connection as there is with migraine.

What causes muscle-contraction headaches?Research has shown that for many people, chronic muscle-contraction headaches are caused by depression and anxiety. Emotional factors are not the only triggers of muscle-contraction headaches. Certain physical postures that tense the head and neck muscles can lead to head and neck pain. So can prolonged writing under poor light, or holding a phone between the shoulder and ear, or even chewing gum.

Risk factors Conditions associated with tension headaches include:

Depression

Anxiety

Teeth clenching or grinding

Insomnia

Sleep apnea

Arthritis in the neck

Women are at greater risk of developing tension headaches than men.

TreatmentTreatment for muscle-contraction headache varies.

The first consideration is to treat any specific disorder or disease that may be causing the headache.

Acute tension headaches not associated with a disease are treated with analgesics.

People with chronic muscle-contraction headaches may also be helped by taking monoamine oxidase (MAO) inhibitors or other antidepressants. Mixed muscle-contraction and migraine headaches are sometimes treated with barbiturate compounds [central-nervous-system depressants].

Nondrug therapy for chronic muscle-contraction headaches includes biofeedback, relaxation training and counseling. People who suffer from infrequent muscle-contraction headaches may benefit from a hot shower or moist heat applied to the back of the neck.

Physical therapy, massage and gentle exercise of the neck may also be helpful.

Excerpted from The Savvy Woman Patient: How and Why Sex Differences Affect Your Health (Capital Books) by the Society for Women’s Health Research.

To learn more about the Society for Women’s Health Research, visit their website.

Identify Your HeadacheWhen that pounding head pain starts, most of us reach for a pain reliever without knowing what type of headache it is. However, figuring out the specific features and symptoms of your headache is an important part of finding the right relief. Take this headache quiz to find out what your pain is telling you.

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